Municipality of Medellín

Background:Rectus abdominis fat grafting (RAFG) has emerged as a valuable adjunct to liposuction and abdominoplasty to enhance muscular definition and abdominal contour. Despite its growing popularity, evidence regarding safety, standardization, and outcomes remains limited. This study described a standardized protocol for ultrasound-guided or direct-vision RAFG and evaluated clinical results, complications, and patient satisfaction.Methods:A retrospective review was conducted on 182 consecutive patients who underwent liposuction or abdominoplasty with intramuscular fat grafting to the rectus abdominis between 2022 and 2024. Fat was injected under high-frequency ultrasound guidance or direct vision during abdominoplasty. Demographics, operative time, graft volumes per metamere, complications, and pre- and postoperative BODY-Q abdomen scores were analyzed.Results:The cohort included 182 patients with a mean age of 37.2 years and a mean body mass index of 26.4 kg/m2. The average fat graft volume per patient was 85 mL, distributed across 4 metameres (15, 20, 20, and 30 mL). Complications directly related to the grafting procedure occurred in 2 patients (1.09%): 1 surgical-site infection and 1 fat necrosis. No cases of fat embolism were observed. Mean BODY-Q satisfaction scores improved from 12.5 to 26.2 on a 28-point scale.Conclusions:RAFG using ultrasound guidance or direct visualization with a metameric, small-volume protocol is a safe, reproducible technique that enhances abdominal definition. Its low complication rate and significant improvement in patient satisfaction support its inclusion in contemporary body contouring practices.

IntroductionBreast cancer remains a leading cause of cancer mortality despite being potentially curable when detected early, particularly in low- and middle-income countries where access to screening is limited. This is largely driven by operational gaps, including limited access to screening and delays in diagnosis and treatment. JULIETA is a portable bioimpedance spectroscopy device designed to identify electrical tissue patterns associated with potentially malignant findings and to prioritize women for further diagnostic evaluation. This study assessed the performance of a hierarchical algorithm integrated into JULIETA to distinguish findings without malignant potential (BI-RADS 1-2) from those with malignant potential (BI-RADS ≥3), using mammography as the reference standard.MethodsA cross-sectional observational study with prospective data collection was conducted between May and July 2024 in four Colombian cities. Adult women undergoing screening or follow-up mammography were evaluated with JULIETA prior to imaging. Impedance-derived features, breast density estimates, and individual risk scores were used to retrain a hierarchical classifier combining Random Forest and SVM-RBF models, using an 80/20 stratified split and cross-validation.ResultsA total of 1350 women were recruited (mean age 56.5 ± 8.0 years); 67% were BI-RADS 1-2 and 21% BI-RADS 4. After data cleaning, 673 breasts (469 women) were included. The model achieved 73% sensitivity, 76% specificity, 65.5% positive predictive value, and 82.1% negative predictive value.ConclusionJULIETA is a feasible, safe, and reproducible noninvasive bioimpedance pre-screening tool that may enable scalable triage and support earlier detection and improved equity when integrated into public health pathways.

Abstract Background Ulcerative colitis (UC) requires effective therapeutic strategies to induce and maintain remission. Upadacitinib, a selective JAK1 inhibitor, has shown strong efficacy in clinical trials; however, real-world evidence in Latin American populations remains scarce. The UPARECOL-UC study evaluated the effectiveness and safety of upadacitinib in Colombian patients with UC during induction (8–16 weeks) and maintenance (24 weeks) under routine clinical practice. Methods A prospective multicentre cohort study was conducted across Colombian reference centres including adults with confirmed UC (clinical, endoscopic, and histological criteria) who initiated upadacitinib between 2024 and 2025 for ≥8 weeks. Effectiveness outcomes included clinical response, clinical remission, and steroid-free remission. Objective biomarkers (C-reactive protein, faecal calprotectin, haemoglobin) were monitored at baseline and follow-up. Safety variables included adverse events (AEs), serious AEs, infections, and treatment discontinuation. Results A total of 47 patients were included in the induction analysis. After 8–16 weeks, clinical remission was achieved in 61.7% (29/47), with steroid-free remission in 71.4% of responders. At week 24, clinical remission increased to 90% (18/20), and steroid-free remission reached 88.2%. Endoscopic remission (Mayo 0–1) was 85% among patients reassessed endoscopically during maintenance. Significant reductions in inflammatory biomarkers were observed during follow-up, supporting clinical improvement. Colectomy occurred in 5.4% of patients during induction, with no colectomies during maintenance. Overall, 30.2% experienced any AE; acne was the most common (25.6%). Serious infections occurred in 4.7% . Treatment discontinuation due to AEs occurred in 9.3% of the cohort. No new safety signals were identified. Conclusion Upadacitinib demonstrated high real-world effectiveness for both induction and maintenance in this Colombian UC cohort, composed largely of patients with severe and treatment-refractory disease. Improvements in clinical outcomes were accompanied by significant reductions in inflammatory biomarkers. The safety profile was consistent with previous clinical and real-world data, supporting upadacitinib as an effective therapeutic option for UC in routine practice. Conflict of interest: Parra Izquierdo, Leidy Viviana: No conflict of interest Gil Parada, Fabio Leonel: No conflict of interest Juliao Baños, Fabián: No conflict of interest Puentes-Manosalva, Fabian Eduardo: No conflict of interest Cuervo-Pico, Pedro-Eduardo: No conflict of interest Galiano, Maria Teresa: No conflict of interest Riveros, Javier: No conflict of interest Gomez Venegas, Alvaro: No conflict of interest Medrano-Almanza, Carlos Andres: No conflict of interest Perea, Daniel: No conflict of interest Ballesteros, Manuel: No conflict of interest Barreto Perez, Jonathan: No conflict of interest Cuadros-Mendoza, Carlos Augusto: No conflict of interest Guzman, Gerardo: No conflict of interest Gutierrez Raba, Aura: No conflict of interest Soto Mora, Jahir: No conflict of interest Dr. Frías-Ordoñez, Juan: No conflict of interest

Abstract Background Defaecatory urgency is a cardinal and distressing symptom in ulcerative colitis (UC), strongly associated with disease activity and reduced quality of life. Its resolution represents a key therapeutic goal, often paralleling mucosal healing and remission. Upadacitinib (UPA), a selective JAK1 inhibitor, has demonstrated robust efficacy for induction and maintenance of remission in UC; however, its specific impact on urgency in real-world Latin American settings remains poorly characterised. Methods We conducted a multicentre observational study including adults with moderate-to-severe UC treated with UPA 45 mg/day for induction and 30 mg/day for maintenance. Changes in defaecatory urgency (present/absent), clinical response (≥3-point decrease in Mayo score), and clinical remission (Mayo < 2) were evaluated at weeks 8–16 (induction) and 24 (maintenance). Biochemical remission was defined as faecal calprotectin < 150 µg/g and/or C-reactive protein < 5 mg/L. Absolute differences were calculated with 95 % confidence intervals (CI), and Fisher’s exact test was applied for categorical variables (p < 0.05). Results A total of 47 patients with UC were included; mean age 39.8 ± 14.6 years; 59.6 % female; 83 % previously exposed to at least one anti-TNF agent. At baseline, 66 % of patients reported defaecatory urgency, which decreased to 31.9 % after induction (Δ − 34.1 %; 95 % CI − 49.5 to − 18.7; p = 0.001) and 25.5 % at six months (p = 0.003). Clinical response was achieved in 81.2 % (95 % CI 66.1–91.4), and clinical remission in 61.7 % (95 % CI 46.4–75.1). Improvement in urgency strongly correlated with clinical remission (r = 0.72; p < 0.001). Biochemical remission (faecal calprotectin < 150 µg/g or CRP < 5 mg/L) occurred in 57.4 % of patients. No serious adverse events were observed; mild transaminase elevations occurred in 8.5 %. Conclusion Upadacitinib rapidly and sustainably reduced defaecatory urgency in Colombian patients with moderate-to-severe UC, with improvement in over two-thirds of cases and a strong association with clinical remission and biomarker normalisation. These findings provide the first real-world Latin American evidence highlighting upadacitinib’s impact on patient-centred symptomatic control in ulcerative colitis, supporting its role as an effective induction and maintenance therapy.

Abstract Background Epidemiological and phenotypic variability across regions for IBD is well recognised; however, data from Latin America (LATAM) remain limited. Furthermore, specific data Crohn’s Disease (CD) related perianal fistula (PF-CD), a severe phenotype of CD is not available from across LATAM countries. This study aimed to compare the demographic, clinical, and phenotypic characteristics of PF-CD across four LATAM cohorts. Methods A retrospective study was conducted including patients with an established diagnosis of PF-CD from Argentina (N = 75), Chile (N = 49), Colombia (N = 145), and Peru (N = 22). Variables assessed included age at fistula diagnosis, CD duration prior to fistula onset, and prior exposure to immunomodulators and corticosteroids. Inter-country comparisons were performed using the chi-square test for categorical variables and the Kruskal–Wallis test for continuous variables. Results Based on the demographic profile described in Table 1, the cohort included 291 patients with a median age of 30 years at Crohn’s disease diagnosis and 31 years at PF-CD diagnosis, with a predominance of non-stricturing, non-penetrating disease (55%) and colonic or ileocolonic involvement (79%). As shown in Table 2, the median delay from CD diagnosis to PF-CD onset was 21 months [6–48], with substantial variation across countries. Overall, 54% of fistulas were classified as simple and 46% as complex. Active proctitis was present in 44% of patients, with the highest proportions observed in Argentina and Peru. Proctectomy was required in 3% of the cohort, though with notable inter-country variation. These findings highlight the clinical heterogeneity of PF-CD across Latin American settings. Conclusion This multicentre LATAM analysis demonstrates substantial inter-country variability in PF-CD presentation, including differences in disease behaviour, fistula complexity, and time to fistula development. Nearly half of patients presented with complex fistulas, and active proctitis was frequent across cohorts. These results underscore the importance of improving early detection and optimising multidisciplinary management. Overall, the findings highlight the phenotypic heterogeneity of PF-CD in Latin America and support the need for region-specific clinical strategies. Conflict of interest: Dr. Pavez, Carolina: No conflict of interest Juliao Baños, Fabián: No conflict of interest Balderramo, Domingo Cesar: No conflict of interest Cedron Cheng, Hugo Guillermo: No conflict of interest Hernandez-Rocha, Cristian: No conflict of interest Parra Izquierdo, Leidy Viviana: None Osorio, Laura: No conflict of interest Gil Parada, Fabio Leonel: No conflict of interest Puentes-Manosalva, Fabian: No conflict of interest Pizarro, Paula A.: No conflict of interest Etchevers, Maria Josefina: No conflict of interest Sobrero, Maria Josefina: No conflict of interest Montero, Joaquin: No conflict of interest Gil, Anibal Hector: No conflict of interest Sanchez, Maria Belen: No conflict of interest Sambuelli, Alicia: no Balaban, Ezequiel: No conflict of interest Rohwain, María José: No conflict of interest Alvarez-lobos, Manuel: No Conflicts Bellolio, Felipe: No conflict of interest Sepúlveda, Ignacia: No conflict of interest Hernandez, Elisa: No conflict of interest Pérez, Tamara: No conflict of interest Estay, Camila: No conflict of interest Rojas, René: No conflict of interest Sepulveda, Rolando: No conflict of interest Perez Alfaro, Ignacio: No conflict of interest Paredes Mendez, Juan: No conflict of interest Cervera Caballero, Luis: No conflict of interest Sebastian, Shaji: No conflict of interest Catalàn-Serra, Ignacio: No conflict of interest

Developmental dysplasia of the hip (DDH) with complete dislocation (grade ≥III) in older patients often requires open reduction. However, achieving long-term stability remains challenging. This study introduces and evaluates a novel surgical technique, intraosseous tunneling and ligamentodesis of the ligamentum teres (LT), conceived to enhance postoperative hip stability while preserving the ligament's anatomic course. Pediatric patients with grade ≥III DDH, as classified by the International Hip Dysplasia Institute (IHDI), underwent open reduction using a novel ligamentum teres ligamentodesis technique to enhance joint stability. The ligament was detached, sutured, and tunneled intraosseously from the fovea to the greater trochanter, then anchored to the periosteum. Postoperative evaluation included gait status, pain, hip range of motion, reluxation, residual dysplasia, avascular necrosis (AVN), physeal bars, growth arrest, complications, and need for reintervention. Nineteen hips in 16 patients (14 females, 2 males) with a median age of 24 months underwent LT intraosseous ligamentodesis combined with femoral and pelvic osteotomies. At a median follow-up of 23 months, all patients were pain-free, had normal gait, and no functional limitations, except for one case of persistent limping and one hip with mild limitation of abduction. Radiographically, all hips achieved satisfactory outcomes with IHDI type I, and severing grades I (80%) and II (20%). No cases of redislocation, dysplasia, infection, physeal bars, or growth arrest were observed. Two hips (10.5%) developed asymptomatic AVN. The ligamentum teres intraosseous ligamentodesis ("Teretization") is a safe and technically feasible adjunct to open reduction in severe DDH, demonstrating favorable mid-term outcomes with no redislocations and low complication rates. These findings support its potential role in enhancing hip stability without jeopardizing femoral head physis and vascularity. Level IV-therapeutic case series. This study evaluates a novel surgical technique in a series of patients with congenital hip dislocation without a control group.

ABSTRACTEvidence for the use of prophylactic anti‐seizure medication (ASM) in traumatic brain injury (TBI) in reducing the occurrence of early post‐traumatic seizure (EPTS) remains equivocal. This study aimed to analyze the prevalence of EPTS in children with TBI, compare clinical characteristics of those with and without EPTS, and explore the association between prophylactic ASM and EPTS. We performed an observational study among 28 pediatric intensive care units in 15 countries from January 2014 to October 2022. The rate of EPTS was compared between individuals prescribed prophylactic ASM and those who were not. Logistic regression was used to examine the association between ASM and EPTS. Among 697 children with TBI, 161 (23.1%) developed EPTS and 280 (40.2%) received prophylactic ASM treatment. Use of prophylactic ASM was associated with a lower likelihood of developing EPTS (27/280 (9.6%) vs. 134/417 (32.1%), p < 0.001). The most frequently used prophylactic ASMs were phenytoin, levetiracetam, and phenobarbital. Age ≤ 4 years and GCS ≤ 8 were associated with increased odds of developing EPTS (aOR 2.29, 95% CI 1.54–3.40, p < 0.001 and aOR 1.80, 95% CI 1.18–2.74, p = 0.01). Our data provide evidence supporting the potential protective role of prophylactic ASM against EPTS.